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Big changes afoot for adults living with disabilities who are Medicare & Masshealth dul beneficiaries

Posted by boston.com  September 19, 2013 10:00 AM

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The following was submitted by the Mystic Valley Elder Services, Inc:

Q: I’m a 35-year-old living in Wakefield and I was permanently disabled in an accident a few years ago. I’m not able to work, and I’ve been receiving medical benefits from both MassHealth (the state’s Medicaid program) and through Medicare.  Keeping up with the paperwork – figuring out which plan covers what procedures and prescriptions – has been a serious chore, and a few times I’ve come close to losing out on coverage simply due to the confusing forms. Please tell me there’s a shortcut somewhere!
 
A: I’m happy to: there’s a new world coming your way in just a few weeks!
 
Starting October 1st, Massachusetts will offer a new health care plan for people between the ages of 21 and 64 who are on Medicare Parts A & B, and MassHealth Standard or CommonHealth (Medicaid). This new plan, ONE CARE, represents a new way for you to manage your health and community care. Created by the 2009 Affordable Care Act (health care reform), One Care is a single program responsible for making sure that you receive the care you need – from Medicare, Medicaid, and other service providers that you choose.
 
In short, One Care means less paperwork and more control for you.
 
If you receive benefits from both MassHealth and Medicare and you’re between 21 and 64, you’ll likely be hearing from MassHealth pretty soon. You’ll receive a description of different providers administering the One Care program, and you’ll be able to select which of these you’d like to work with. You may also opt not to participate in the One Care program at all.
 
(If you decline to make the decision on your own, and if there are two or more One Care providers in your county, MassHealth will automatically enroll you with a One Care provider. Even if you are automatically enrolled, you will still have control over your care and be able to select which community-based organization you work with. You may also opt out after you are auto-enrolled. As of October 2013, Suffolk County has two One Care providers; Middlesex and Essex Counties have only a single One Care provider, so if you live in Middlesex, you won’t be auto-enrolled.)
 
In anticipation of One Care, Mystic Valley Elder Services has created new program to provide One Care participants with the community-based services they desire: Mystic Valley Community Care. So, after you’ve enrolled, One Care will help you assemble a brand new care team. The care team, LED BY YOU, will include a primary care provider (PCP), a care coordinator, and, if you choose, Mystic Valley Community Care. The team will be centered around your needs and preferences.
 
The control will be in your hands at all times – just where it belongs.
 
Your care team will work with you to help you access expanded services, such as additional dental care, vision, and medical equipment benefits. You’ll also have the option of participating in Mystic Valley Community Care’s new community-based services. We’ll provide you with the support you need to live where you want: at home.
 
 
To get more information from MassHealth, call their Customer Service number at 1-800-841-2900 or visit www.mass.gov/masshealth/onecare.
 
If you’d like to see a bit more of what Mystic Valley Community Care will offer, visit www.community-care.org.
 
Here’s to your health, your peace of mind, and to less paperwork!
Daniel O’Leary
 

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